Promoting civility and safety with cognitive rehearsal.

ABSTRACT: Uncivil behaviors have detrimental consequences that can impact healthcare team cohesion, resulting in conflicts and poor teamwork. This article details civil and uncivil behaviors and how the latter affects healthcare, and provides a tool to prepare nurses for uncivil encounters.

The conserved C-terminus of Sss1p is required to maintain the endoplasmic reticulum permeability barrier.

The endoplasmic reticulum (ER) is the entry point to the secretory pathway and major site of protein biogenesis. Translocation of secretory and integral membrane proteins across or into the ER membrane occurs via the evolutionarily conserved Sec61 complex, a heterotrimeric channel that comprises the Sec61p/Sec61α, Sss1p/Sec61γ, and Sbh1p/Sec61ß subunits. In addition to forming a protein-conducting channel, the Sec61 complex also functions to maintain the ER permeability barrier, preventing the mass free flow of essential ER-enriched molecules and ions. Loss in Sec61 integrity is detrimental and implicated in the progression of disease. The Sss1p/Sec61γ C terminus is juxtaposed to the key gating module of Sec61p/Sec61α, and we hypothesize it is important for gating the ER translocon. The ER stress response was found to be constitutively induced in two temperature-sensitive sss1 mutants (sss1ts ) that are still proficient to conduct ER translocation. A screen to identify intergenic mutations that allow for sss1ts cells to grow at 37 °C suggests the ER permeability barrier to be compromised in these mutants. We propose the extreme C terminus of Sss1p/Sec61γ is an essential component of the gating module of the ER translocase and is required to maintain the ER permeability barrier.

Diminished Ost3-dependent N-glycosylation of the BiP nucleotide exchange factor Sil1 is an adaptive response to reductive ER stress.

BiP (Kar2 in yeast) is an essential Hsp70 chaperone and master regulator of endoplasmic reticulum (ER) function. BiP's activity is regulated by its intrinsic ATPase activity that can be stimulated by two different nucleotide exchange factors, Sil1 and Lhs1. Both Sil1 and Lhs1 are glycoproteins, but how N-glycosylation regulates their function is not known. Here, we show that N-glycosylation of Sil1, but not of Lhs1, is diminished upon reductive stress. N-glycosylation of Sil1 is predominantly Ost3-dependent and requires a functional Ost3 CxxC thioredoxin motif. N-glycosylation of Lhs1 is largely Ost3-independent and independent of the CxxC motif. Unglycosylated Sil1 is not only functional but is more effective at rescuing loss of Lhs1 activity than N-glycosylated Sil1. Furthermore, substitution of the redox active cysteine pair C52 and C57 in the N terminus of Sil1 results in the Doa10-dependent ERAD of this mutant protein. We propose that reductive stress in the ER inhibits the Ost3-dependent N-glycosylation of Sil1, which regulates specific BiP functions appropriate to the needs of the ER under reductive stress.

Energetic and informational masking of complex sounds by a bottlenose dolphin (Tursiops truncatus).

With few exceptions, laboratory studies of auditory masking in marine mammals have been limited to examining detection thresholds for simple tonal signals embedded in broadband noise. However, detection of a sound has little adaptive advantage without the knowledge of what produced the sound (recognition) and where the sound originated (localization). In the current study, a bottlenose dolphin's masked detection thresholds (energetic masking) and masked recognition thresholds (informational masking) were estimated for a variety of complex signals including dolphin vocalizations, frequency modulated signals, and a 10 kHz pure tone. Broadband noise types included recordings of natural sounds and computer generated sounds. Detection thresholds were estimated using a standard go, no-go adaptive staircase procedure. The same dolphin learned to associate whistle-like FM sounds with specific arbitrary objects using a three alternative, matching-to-sample (MTS) procedure. The dolphin's performance in the MTS task was then tested in the presence of the same masking noise types used in the detection task. Recognition thresholds were, on average, about 4 dB higher than detection thresholds for similar signal-noise conditions. The 4 dB difference is likely due to additional cognitive demands of recognition, including attention and pattern recognition.

Multi-echo processing by a bottlenose dolphin operating in "packet" transmission mode at long range.

Bottlenose dolphins performing echolocation tasks at long ranges may utilize a transmission mode where bursts, or "packets," of echolocation clicks are emitted rather than single clicks. The clicks within each packet are separated by time intervals well below the two-way travel time, while the packets themselves are emitted at intervals greater than the two-way travel time. Packet use has been shown to increase with range; however, the exact function of packets and the advantages gained by their utilization remain unknown. In this study, the capability for dolphins to utilize multi-echo processing within packets of echoes was investigated by manipulating the number of available echoes within each packet as a dolphin performed a long-range echolocation task. The results showed an improvement in detectability with an increase in the number of echoes in each packet and suggest that packet use is an adaptation to allow multi-echo processing at long ranges without introducing range ambiguity.

Discrimination of mixed-directional whistles by a bottlenose dolphin (Tursiops truncatus).

Dolphins are hypothesized to deduce the swimming direction of group members by attending to the spectral pattern of whistle harmonics. This is known as the direction of movement cue hypothesis and may facilitate coordination of complex group behavior when visibility is poor. The direction of movement cue hypothesis hinges on the assumption that dolphins can discriminate between whistles with different harmonic patterns that are associated with signaler orientation. This assumption was tested with a bottlenose dolphin. Whistles were recorded from a dolphin at different azimuth positions (0° to 180° in 45° increments). Noise-free, synthetic whistles were created to mimic the direction-dependant spectral profiles of the recorded whistles. A dolphin was then tested in its ability to discriminate between the synthetic whistles using fixed level and roving level conditions. The dolphin's discrimination performance in both the fixed and roving level conditions was near 100% for whistles separated by angles greater than 45°, and near chance for 45° separations. Computer simulations of the task, along with the dolphin's performance, suggest that the dolphin's discrimination was level invariant and based on the spectral pattern of the whistles.

Auditory masking patterns in bottlenose dolphins (Tursiops truncatus) with natural, anthropogenic, and synthesized noise.

Auditory masking occurs when one sound (usually called noise) interferes with the detection, discrimination, or recognition of another sound (usually called the signal). This interference can lead to detriments in a listener's ability to communicate, forage, and navigate. Most studies of auditory masking in marine mammals have been limited to detection thresholds of pure tones in Gaussian noise. Environmental noise marine mammals encounter is often more complex. In the current study, detection thresholds were estimated for bottlenose dolphins with a 10 kHz signal masked by natural, anthropogenic, and synthesized noise. Using a band-widening paradigm, detection thresholds exhibited a pattern where signal thresholds increased proportionally to bandwidth for narrow band noise. However, when noise bandwidth was greater than a critical band, masking patterns diverged. Subsequent experiments demonstrated that the auditory mechanisms responsible for the divergent masking patterns were related to across-channel comparison and within-valley listening.

Bottlenose dolphin (Tursiops truncatus) detection of simulated echoes from normal and time-reversed clicks.

In matched filter processing, a stored template of the emitted sonar pulse is compared to echoes to locate individual replicas of the emitted pulse embedded in the echo stream. A number of experiments with bats have suggested that bats utilize matched filter processing for target ranging, but not for target detection. For dolphins, the few available data suggest that dolphins do not utilize matched filter processing. In this study, the effect of time-reversing a dolphin's emitted click was investigated. If the dolphin relied upon matched filter processing, time-reversal of the click would be expected to reduce the correlation between the (unaltered) click and the echoes and therefore lower detection performance. Two bottlenose dolphins were trained to perform a phantom echo detection task. On a small percentage of trials ("probe trials"), a dolphin's emitted click was time-reversed before interacting with the phantom echo system. Data from the normal and time-reversed trials were then analyzed and compared. There were no significant differences in detection performance or click emissions between the normal and time-reversed conditions for either subject, suggesting that the dolphins did not utilize matched filter processing for this echo detection task.

The effect of positive and negative evaluation on state anxiety and repetitive negative thinking in social evaluative situations: An experimental study.

The Bivalent Fear of Evaluation (BFOE) Model suggests that fears of negative and positive evaluation are core cognitive vulnerability and maintenance factors for social anxiety disorder The aim of this study was to experimentally assess cognitive and emotional effects of positive and negative feedback in social anxiety. False positive or negative feedback (vs no feedback) was provided following a speech task to high and low socially anxious individuals to investigate impacts on state anxiety and repetitive negative thinking (N = 152, Mage = 22.13, 69 % female). Measures were completed prior to the speech and after the false feedback but prior to an anticipated discussion with the group about participants' feedback and performance. High socially anxious participants reporting higher state anxiety and repetitive negative thinking than low socially anxious participants. There were no feedback type by group interactions, indicating that high socially anxious individuals experienced heightened social anxiety and repetitive negative thinking regardless of feedback type (or the absence of feedback). Exploratory analyses revealed that state fear of negative evaluation but not state fear of positive evaluation uniquely predicted both outcomes. Implications for theory and clinical practice are discussed.

A co-designed systematic review and meta-analysis of the efficacy of grief interventions for anxiety and depression in young people.

BACKGROUND: Grief in young people is common and associated with symptoms of anxiety and depression, yet grief interventions for this age group are under-researched. METHOD: We conducted a systematic review and meta-analysis to examine the efficacy of grief interventions in young people. The process was co-designed with young people and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PsycINFO, Medline, and Web of Science databases were searched in July 2021 (updated December 2022). RESULTS: We extracted results from 28 studies of grief interventions with young people (14-24 years) that measured anxiety and/or depression (N = 2803 participants, 60 % girls/women). Cognitive behavior therapy (CBT) for grief demonstrated a large effect for anxiety and medium effect for depression. A meta-regression indicated that CBT for grief that included a higher degree of CBT strategies, was not trauma focused, had >10 sessions, offered on an individual basis, and did not involve parents, was associated with larger effect sizes for anxiety. Supportive therapy had a moderate effect for anxiety and a small-moderate effect for depression. Writing interventions were not effective for anxiety or depression. LIMITATIONS: Studies are limited in number and there were few randomized controlled studies. CONCLUSIONS: Findings indicate that CBT for grief is an effective intervention for reducing symptoms of anxiety and depression in young people experiencing grief. CBT for grief should be offered as the first line treatment for grieving young people experiencing anxiety and depression. PROTOCOL REGISTRATION: PROSPERO (registration number CRD42021264856).

IgG antibody production and persistence to 6 months following SARS-CoV-2 vaccination: A Northern Ireland observational study.

BACKGROUND: This study evaluates spike protein IgG antibody response following Oxford-AstraZeneca COVID-19 vaccination using the AbC-19™ lateral flow device. METHODS: Plasma samples were collected from n = 111 individuals from Northern Ireland. The majority were >50 years old and/or clinically vulnerable. Samples were taken at five timepoints from pre-vaccination until 6-months post-first dose. RESULTS: 20.3% of participants had detectable IgG responses pre-vaccination, indicating prior COVID-19. Antibodies were detected in 86.9% of participants three weeks after the first vaccine dose, falling to 74.7% immediately prior to the second dose, and rising to 99% three weeks post-second vaccine. At 6-months post-first dose, this decreased to 90.5%. At all timepoints, previously infected participants had significantly higher antibody levels than those not previously infected. CONCLUSION: This study demonstrates that strong anti-spike protein antibody responses are evoked in almost all individuals that receive two doses of Oxford-AstraZeneca vaccine, and which largely persist beyond six months after first vaccination.

Treatment of the term newborn with brain injury: simplicity as the mother of invention.

Neonatal brain injury remains a common cause of developmental disability, despite tremendously enhanced obstetrical and neonatal care. The timing of brain injury occurs throughout gestation, labor, and delivery, providing an evolving form of brain injury and a moving target for therapeutic intervention. Nonetheless, markedly improved methods are available to identify those infants injured at birth, via clinical presentation with neonatal encephalopathy and neuroimaging techniques. Postischemic hypothermia has been shown to be of tremendous clinical promise in several completed and ongoing trials. As part of this approach to the treatment of the newborn, other parameters of physiologic homeostasis can and should be attended to, with strong animal and clinical evidence that their correction will have dramatic influence on the outcome of the newborn infant. This review addresses aspects of newborn care to which we can direct our attention currently, and which should result in a safe and efficacious improvement in the prognosis of the newborn with neonatal encephalopathy.

Effect of caffeine and morphine on the developing pre-mature brain.

Apnea of pre-maturity is common, occurring in 85% of infants born less than 34 week gestation. Oral caffeine is the most frequent form of therapy, often in conjunction with the use of intubation and intermittent ventilation. Morphine is used to reduce the pain believed to be associated with the latter. Little information is available on the effects of caffeine, morphine or their combination, on the developing brain. We determined the effect of caffeine and morphine alone and in combination of cell death on the developing brain of the rat. Cell death, measured by Fluoro-jade B and activated caspase-3, was significantly increased at 12 and 24 hour post-caffeine injection (P < 0.05) in the cortex, caudate, nucleus accumbens, hypothalamus, hippocampus and superior colliculus. No alterations were seen following morphine injection alone. However, in the thalamus, the combination of caffeine and morphine did increase cell death to a significantly greater extent than caffeine alone. Further research is required to determine the long-term pathologic and functional effects of caffeine and the combination of caffeine and morphine on the developing immature brain.

Treatment of malignant tumors of the proximal humerus with allograft-prosthesis composite reconstruction.

Malignant tumors of the proximal humerus are challenging to treat. Reconstruction with a metallic implant or allograft is the most common method, but each has known risks and frequent complications. Allograft-prosthesis composite reconstruction has not been widely used and may avoid problems posed by metal prostheses or allografts used alone. Six patients with malignant tumors of the proximal humerus were treated with allograft-prosthesis composite reconstruction after excision of the intra-articular tumor. Outcomes were assessed by use of the Disabilities of the Arm, Shoulder and Hand questionnaire; the Short Form 36 (SF-36) Health Survey; and the American Shoulder and Elbow Surgeons Shoulder Assessment Form. Preoperative and postoperative scores at a mean of 55 months were compared. Disability increased after surgery based on the Disabilities of the Arm, Shoulder and Hand questionnaire and SF-36, although disability appeared to decrease with time. The mean mental component score on the SF-36 showed continued improvement with time after surgery. One asymptomatic nonunion was repaired, and painful loosening developed in one patient, requiring revision at 45 months. Allograft-prosthesis composite reconstruction is a safe method for treating some malignant tumors of the proximal humerus, providing stable reconstruction and preserving function of the shoulder joint.